Mouth Preparation in

Removable Partial Denture

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The preparation of the mouth is fundamental to a successful removable partial denture service. The
prescribed prosthesis must not only replace what is missing but also preserve the remaining tissue and
structures that will enhance the removable partial denture.
Mouth preparation follows the preliminary diagnosis and the development of a tentative treatment plan.
Mouth preparation includes procedures in four categories:
1. Oral surgical preparation
2. Conditioning of abused and irritated tissue
3. Periodontal preparation, and
4. Preparation of abutment teeth.

The objectives of the procedures involved in all the four areas are to return the mouth to optimum health
and to eliminate any condition that would be detrimental to the success of the partial denture. Mouth
preparation must be accomplished before the impression procedures that will produce the master cast on
which the removable partial denture will be fabricated. Oral surgical and periodontal procedures should
precede abutment tooth preparation and should be completed far enough in advance to allow the
necessary healing period.

Objectives of Tooth Alteration

1. One important objective in tooth alteration is to prepare the teeth that are to be clasped, so that the
occlusal (lingual-incisal) rest directs stress along the long axis of the tooth.
2. Another objective is to prepare the mouth so that the prosthesis can be inserted and removed by
the patient without having it transmit wedging or torsional types of stress against the teeth with
which it comes in contact.
3. Another objective is the recontouring which will eliminate interference or otherwise contribute to
a better design.
4. Finally, retention can be created, by a simple alteration procedure, in a tooth surface where none
formerly existed.

Oral Surgical preparation

As a rule, all surgical treatment for the RPD patient should be completed as early as possible.
1.Extraction: Planned extraction should occur early in the treatment regimen. The extraction of non-
strategic teeth that would present complications or those that may be detrimental to the design of the
partial denture is a necessary part of overall treatment plan.

2.Removal of residual roots: All retained roots or root fragments are removed particularly if they are in
close proximity to the tissue surface or if there is evidence of associated pathology. Residual roots
adjacent to abutment teeth may contribute to the progression of periodontal pockets.

3.Impacted Teeth: All impacted teeth are considered for removal. Early elective removal of impacted
teeth prevents later serious acute and chronic infections with extensive bone loss, which may occur. The
periodontal implications of the impacted teeth adjacent to the abutments are similar to those of the
retained roots. Asymptomatic impacted teeth in the elderly that are covered with bone with no evidence of
a pathological condition should be left to preserve the arch morphology. Patient should be informed about
its presence.

4.Malposed Teeth: The loss of individual teeth or groups of teeth may lead to extrusion, mesial drifting or
combination of malfunctioning of remaining teeth. Orthodontics may be useful in correcting many
occlusal discrepancies. If orthodontic treatment is not possible because of lack of teeth for anchorage,
individual teeth or groups of teeth and their supporting alveolar bone can be surgically repositioned.

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5.Cysts and Odontogenic tumors: Panoramic radiographs of the jaw are recommended to survey the jaws
for unsuspected pathology. All radiolucencies or radioopacities observed should be investigated. If
necessary perform a biopsy of the area and send it to pathologist for microscopic examination.

6. Exostoses and tori: The existence of abnormal bony enlargements compromise the design of the RPD.
Modification in the denture design sometimes can accommodate the exostoses, but frequently this results
in additional stress being applied to the supporting elements and hence compromises function. Normally
the mucosa covering the bony protuberances is extremely thin and friable. The RPD components in
proximity to this type of tissue can cause irritation and chronic ulceration.

7. Hyperplastic Tissue: Hyperplastic tissue are seen in the form of

- Fibrous tuberosities
- Soft flabby ridges
- Folds of redundant tissue in vestibule/floor of mouth.
- Palatal papillomatosis.
All this forms of excess tissue should be removed to provide a firm base for the denture.

8.Muscle Attachments and Frena: Due to loss of alveolar bone height, muscle attachments get inserted
on or near the residual ridge crest. The mylohyoid, buccinator, mentalis, genioglossus muscles are those
more likely to create problems of this kind. Appropriate ridge extension procedures can reposition
attachments and remove bony spines. Frenum should not be allowed to compromise the design or comfort
of a RPD.

9. Bony spines and knife edge ridges: Sharp bony spicules should be removed and knife like crests
greatly rounded.

10. Polyps, Papillomas, Traumatic Haemangiomas: All abnormal soft tissue lesions should be excised
and submitted for pathologic examination before fabrication of RPD. Additional stimulation to the area
by the prosthesis may produce discomfort or even malignant changes in the tumor.

11. Hyperkeratosis, Erythroplasia, and Ulcerations: All abnormal white, red or ulcerative lesions should
be investigated. The lesions should be removed and healing accomplished before fabrication of the partial
dentures.

12. Dentofacial deformity: Patient with dentofacial deformity often have multiple missing teeth as part of
their problem. Surgical correction of jaw deformity can be made in a horizontal, sagittal or frontal planes.
Mandibles and maxillae may be positioned anteriorly or posteriorly and their relationship to the facial
planes may be surgically altered to achieve improved appearance.

13. Osseo integrated devices: The fixtures or endosseous implants are constructed from relatively pure
titanium. These implants are placed using clean and controlled oral surgical procedures and are allowed to
heal before fabrication of a dental prosthesis.

14. Augmentation of alveolar bone: Considerable attention has been devoted to ridge augmentation with
the use of autogenous and alloplastic materials, especially in preparation for implant placement.
Hydroxyapatite is successfully used as a material for augmentation of deficient alveolar bone. There is
evidence that in addition to providing increase in ridge width and height, the hydroxyapatite material
provides a matrix for new bone formation.

Conditioning of abused and irritated tissues: Patients who require conditioning treatment often
demonstrate the following symptoms:
1. Inflammation and irritation of the mucosa covering the denture bearing areas.
2. Distortion of normal anatomic structures such as incisive papillae, the rugae and retromolar pads

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3. Burning sensation in residual ridge areas, the tongue, cheeks and lips.
These conditions usually associated with ill-fitting or poorly occluding R.P.D’s. First treatment procedure
should be an immediate institution of a good home care program, which includes:
a. Rinsing the mouth 3 times a day with prescribed saline solution.
b. Massaging the residual ridge area, palate, and tongue with a soft toothbrush.
c. Removing prosthesis at night.
d. Using prescribed therapeutic multivitamin along with a prescribed high protein, low carbohydrate diet.
e. Use of tissue conditioning materials, which are elastopolymers that continue to flow for an extended
period, permitting distorted tissues to rebound and assume their normal form.

Periodontal Preparation:
Periodontal preparation of mouth usually follows any oral surgical procedures and is performed
simultaneously with tissue conditioning procedures. Periodontal therapy is completed before restorative
dentistry procedures are begun.

Objectives:
1. Return to the health of supporting structures of the teeth
2. Create an environment in which periodontium may be maintained

Specific criteria for satisfying the objectives:

1. Removal and control of all etiologic factors contributing the periodontal disease
2. Elimination / reduction of all pockets with establishment of healthy gingival sulci.
3. Establishment of functional atraumatic occlusal relationships.
4. Development of a personal plaque control program and definitive maintenance schedule.

Periodontal diagnosis and treatment planning

Diagnosis
The diagnosis of periodontal diseases is based on a systematic and carefully accomplished examination of
the periodontium. It follows the procurement of the health history of the patient and is performed using
direct vision, palpation, periodontal probe, mouth minor, and other auxiliary aids, such as curved
explorers, furcation probes, diagnostic casts, and roentgenograms.
In the examination procedure, nothing is as important as the careful exploration of the gingival sulcus
and recording of the probing pocket depth with a suitably designed instrument. Under no circumstances
should partial denture fabrication begin without an accurate appraisal of sulcus depth and health, as
provided by use of the probe. The probe is inserted gently but firmly between the gingival margin and the
tooth surface, and the depth of the sulcus is determined circumferentially around each tooth. At least six
sulcus/pocket depth readings are recorded on the patient's chart. Usually depths are recorded for the
distobuccal, mesial, mesiobuccal, distolingual, lingual, and mesiolingual aspects of each tooth.
A critical assessment of sulcular health, by judging the amount of bleeding produced on probing, is
considered an important indication of sulcus condition and, along with pocket depth, is an excellent
indicator of health and disease.
Dental roentgenograms are used to supplement the clinical examination but cannot be used as a substitute
for it. The extent and pattern of bone loss can be estimated from roentgenograms. Considerations should
include but not be limited to the following: (1) type, location, and severity of bone loss; (2) location,
severity, and distribution of furcation involvement; (3) alterations of periodontal ligament space; (4) alter-
ations of the lamina dura; (5) calcified deposits; (6) location and conformity of restorative margins; (7)
evaluation of crown and root morphologies; (8) root proximity; (9) caries; and (10) evaluation of other
associated anatomic features, such as the "mandibular canal or sinus proximity. This information serves to
substantiate the impression gained from the clinical examination.
Each tooth should be evaluated carefully for mobility. Unfortunately, there is no universally accepted
standard for mobility. In general, mobility is graded according to the ease and extent of tooth movement.

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Normal mobility is in the order of 0.05 to 0.10 mm. Grade I mobility is slightly more than normal(less
than 1mm); Grade II – 1 to 2 mm buccolingually, and Grade III is severe mobility (greater than 2mm)
combined with vertical depressability.
The degree of mobility present, coupled with a determination of the etiologic factor responsible,
provides additional information, which is invaluable in planning for the removable partial denture. If the
etiologic factor can be removed, many Grade I and Grade II mobile teeth will become stable and can be
used successfully to help support, stabilize, and retain the partial denture. Mobility is not in itself an
indication for extraction unless the mobile tooth cannot aid in the support or stability of the partial denture
or the mobility cannot be reduced. (Grade III cannot be reversed and will not provide support or stability.)
Mobility is an indication of the condition of the supporting structures and is caused by inflammatory
changes in the periodontal ligament, traumatic occlusion, or loss of attachment. Most often it is a result of
a combination of the three.

Periodontal treatment planning divided into 3 phases:

Phase I- Initial disease control therapy-
● Oral hygiene instructions-patients instructed on the use of disclosing wafers/tablets, soft/medium
bristle toothbrush and unwaxed/waxed dental floss.
● Scaling and root planing: are done before performing surgical procedure- ultrasonic instrumentation
and sharp periodontal curettes
● Elimination of local irritating factors other than calculus: overhanging margins of restoration, open
contacts lead to food impaction should be corrected before definitive treatment is begun.
● Elimination of gross occlusal interferences: traumatic cuspal interference is removed by selective
grinding procedure.

Temporary Splinting
The response of theseteeth to temporary immobilization, followed by appropriate treatment, may be a
helpful indicator in establishing a prognosis for them and may lead
to a rational decision as to whether they should be retained or sacrificed. Secondary mobility resulting
from the presence of an inflammatory lesion may be reversible if the disease process has not destroyed
too much of the attachment apparatus. Primary mobility caused by occlusal interference also may
disappear after selective grinding. In instances of angular types of osseous defects, one should consider
guided tissue regeneration as a means of increasing attachment levels. In some situations, however, the
teeth must be stabilized because of loss of supporting structure from the periodontal process. Teeth may
be immobilized during periodontal treatment by acid etching teeth with composite resin, with fiber
reinforced resins, with cast removable splints, or with intracoronal attachments. The latter, an example of
which is the A-splint, necessitates cutting tooth surfaces and embedding a ridge connector between
adjacent teeth. After periodontal treatment, splinting may be accomplished with cast removable
restorations or cast cemented restorations. The preferred form of permanent splinting is with two or more
cast restorations soldered or cast together. They may be cemented with either permanent (zinc
oxyphosphate or resin) cements or temporary (zinc oxide-eugenol) cements. A properly designed
removable partial denture can also stabilize mobile teeth if provision for such immobilization is planned
as the denture is designed.

Use of a Nightguard
The removable acrylic resin splint, originally designed as an aid in eliminating the deleterious effects of
nocturnal clenching and grinding, has been used to advantage for the removable partial denture patient.
The nightguard may be helpful as a form of temporary splinting if worn at night after the removal of the
removable partial denture. The flat occlusal surface prevents the intercuspation of the teeth, which
eliminates lateral occlusal forces The nightguard is particularly useful before fabrication of a removable
partial denture when one of the abutment teeth has been unopposed for an extended period. The
periodontal ligament of a tooth without an antagonist undergoes changes characterized by a loss of

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orientation of periodontal ligament fibers, loss of supporting bone, and narrowing of the periodontal
ligament space. If such a tooth is suddenly returned to full function when it is carrying an increased
burden, pain and prolonged sensitivity may result. However, if a nightguard is used to return some
functional stimulation to the tooth, the periodontal ligament changes are reversed and an uneventful
course can be experienced when the tooth is returned to full function.

Phase II – Definitive periodontal surgery.

●Root planing: considered for reduction of pockets when the cause of pocket depth is edema caused by
gingival inflammation.
● apically positioned flap surgery or occasionally a gingivectomy may be considered for reduction of
suprabony pockets.
● periodontal flap: to gain access for root planning, osseous recontouring indicated for elimination of
pocket depth, when crown lengthening is needed, and for regenerative procedures such as osseous grafts
and GTR.
● mucogingival procedures: helpful in establishing a zone of attached gingiva on the teeth that has been
previously destroyed by periodontal disease.. e.g. free gingival graft, pedicle flap and lateral positioned
flap.

Phase III- Recall maintainence- patients with a history of moderate to severe periodontitis should be
placed on a 3- 4 month recall system to maintain results achieved by surgical or nonsurgical therapy.

Classification of abutment teeth:

I- Those abutment teeth that require only minor modifications to their coronal fractions.
II- Those that are to have restorations other than crowns.
III- Those that are to have crowns.
Design philosophies of RPD’s have progressed considerably since the first published description in 1711.

6 steps of mouth and tooth preparation are given in chronological order:

Establishing occlusal plane: The glossary of prosthodontic terms describes occlusal plane as ‘the
average plane established by the incisal and occlusal surfaces of the teeth, it is not a plane, but represents
the planar means of curvature of these surfaces. When a tooth is lost in an arch remaining teeth tend to
drift. Particularly when posterior teeth are lost, remaining posterior teeth, attempting to close the space,
tip mesially. Thus the mesial portion of occlusal surface is out of contact with opposing occlusion, and
distal portion in supraocclusion. Teeth also extrude when occlusal contact of teeth of opposing arch lost.
The occlusal plane in most partially edentulous mouths will be uneven. Teeth that have been unopposed
for long time will tend to overerupt. Maxillary molars if not opposed tend to migrate downward, carrying
the bony tuberosity downwards along. When occlusal plane is not in harmony with dental arches,
placement of artificial teeth and creation of a ‘ harmonious functional occlusion becomes difficult or
impossible to accomplish. Normally the occlusal plane is corrected by reducing the height of overerupted
teeth.
Clinical treatment options:
● Determine whether occlusal plane can be corrected by judicious reshaping of enamel by removing up to
2mm enamel. Dentine should not be exposed.
● If more than 2mm of enamel to be removed, tooth should be restored. Enough tooth structure removed
for a cast restoration to have adequate thickness.
There are times when the clinical crown requires lengthening to restore the occlusal plane, such as when
teeth fail to erupt fully because of interferences from other teeth or lack of stimulation. This condition is
most often corrected by orthodontic treatment or the placement of cast onlays or crowns. Tipped molars
also present problems in establishing a harmonious occlusal plane. Loss of teeth anterior to the molars to
drift mesially and in doing so to tip. The ideal treatment is to upright teeth orthodontically, if not possible

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the occlusal plane may be reestablished by using crowns, onlays, or the rpd itself in form of onlay
occlusal rests.

● Enameloplasty:
Enameloplasty is a coined word used to describe the removal of a portion of the enamel surface of a tooth
for the correction of the occlusal plane; the enameloplasty consists of reducing cusp height in order to
level or harmonize the curve of the occlusal plane. When the cusp height is reduced, the anatomy of the
occlusal surface should not be mutilated. In older patients where considerable wear of occlusal surfaces
has taken place with resultant deposition of secondary dentin, slightly more tooth reduction without
endangering the tooth or producing sensitivity. Functional cusps with accessory grooves and sluiceways
must be restored to the teeth once the necessary reduction has been made. Unopposed maxillary molars
tend to roll towards facial surface as extrusion takes place. This rotation causes lingual cusp in particular
to drop below occlusal plane. The actual reduction of the enamel surface is best accomplished by using
tapered diamond cylinder stones.

● Onlay
The use of onlay occlusal rests was rather common a number of years ago, before the advent of high-
speed dental equipment, as a conservative method of correcting the plane of occlusion. The occlusal
surface of a tooth to be covered by an onlay rest should be free of pits and fissures or should be made so
by eliminating the defects with small burs or stones. The smooth occlusal surface helps prevent caries
caused by dental plaque and other debris being trapped.
The use of onlay rest on a tooth that has been restored with a cast onlay or crown is redundant because the
restoration itself should be used to restore the occlusal plane; the onlay rest would be superfluous.
If the onlay rest is to be constructed of chrome alloy, any opposing natural teeth should not occlude
directly against the rest. Chrome alloy, being extremely hard will cause rapid wear of the opposing
enamel surfaces. Under these circumstances, the chrome metal should be constructed short of occlusal
contact and the surface of the metal covered with projections of metal beads. Tooth-colored acrylic resin
may be processed on the surface of the onlay rest with the beads used to retain the resin. Opposing natural
teeth may then occlude against this resin without danger of wearing tooth surface. However acrylic resin
will wear fairly rapidly and will require replacement more frequently than an acrylic resin denture tooth.
One of the simplest methods of reestablishing the plane of occlusion is by the use of cast gold onlays,
which can either lengthen or shorten the crown height of a tooth.
One of the main advantages of the onlay is that the natural contours of the facial and lingual enamel
surfaces can be maintained. This is normally an objective if the periodontal health of the tooth is optimal
under the existing conditions. There has been a tendency toward full crown restoration in preference to
partial crown or onlay restorations in recent years, possibly because patient insistence on esthetics has
become the primary consideration during the treatment-planning phase. The cast onlay does present a
problem of securing an adequate retention form for the restoration. If the tooth bearing the onlay is also to
be a primary abutment for the removable partial denture (that is, is to have a retentive extra coronal
clasp), the retentive clasp tip should not engage an undercut in the onlay; it must be on the enamel
surface. If this is not possible, the onlay is not indicated and a full crown should be planned for that tooth.

● Crowns
When the crown height of the tooth must be changed to harmonize the occlusal plane, and the facial,
lingual, or proximal surfaces must be altered to produce a more desirable height of contour, a guiding
plane, or a retentive undercut, a full crown is normally the restoration of choice.
Before the tooth is prepared to receive the crown, mounted diagnostic casts should be measured to
ascertain how much crown reduction is necessary to correct the occlusal plane. If the reduction of tooth
structure will be so great as to endanger the dental pulp, a decision must be made as to whether
endodontic treatment is indicated or whether this extent of treatment is not warranted and extraction
would be the treatment of choice.

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● Endodontics with Crown or Coping
Abutment teeth are often overerupted and have lost some of the periodontal support needed to serve as an
abutment. If this is the case, endodontic therapy and, if inter-occlusal space is available, construction of
crown will allow the teeth to serve as normal abutments.
If the over eruption has been so gross as to nearly obliterate the remaining interarch space, the crown of
the tooth can be removed at the gingival crest and a coping constructed. The tooth will serve as a vertical
stop, preventing excessive vertical or horizontal movement of the prosthesis preparing the abutment tooth
to serve as an overdenture abutment.

● Extraction
It should be the goal of the designer of removable partial dentures to retain as many of the remaining teeth
as possible. However, at times retaining certain teeth can greatly complicate or even compromise the
success of the treatment. For example, if orthodontic treatment cannot be accomplished to realign
severely malposed molars or pre-molars, extraction must be considered. When the teeth interfere with the
placement of the major connector and no other solution (such as crowning the tooth) is feasible,
extraction must be planned.

● Surgery
Surgical repositioning of one or both jaws or of segments of one or both jaws to correct malrelationship
of teeth is not a new procedure.
Various forms of mandibulectomies, usually to correct gross prognathic jaw relationships, have been
performed with great success for a number of years.
Of particular interest in the area of reestablishing harmony of the occlusal plane is the procedure of
superiorly repositioning posterior segments of the maxillae containing the posterior teeth, a maxillary
segmental osteotomy. The segment (including the alveolar ridge, tuberosity, and the teeth is elevated into
the maxillary sinus. This is one of the most effective methods of regaining interarch space lost because of
downward migration of the teeth and tuberosity.

Correction of Malalignment
Teeth that are malposed facially or lingually are frequently more difficult to correct than overerupted or
submerged teeth. There are definite limitations to the repositioning of these malposed teeth. Often it is
design of the removable partial denture that must be altered rather than the tooth position.

● Orthodontic Realignment: The technique of orthodontically moving the malpositioned tooth should be
considered first. Unfortunately it is often not possible to use this method. In many mouths where a large
number of teeth are missing there may not be enough remaining teeth to serve as an anchor from where
the moving force can be applied.

● Crowns: Teeth that are not grossly out of position facially or lingually can occasionally be improved by
a partial or full crown restoration. It is possible to treat the tooth endodontically and use a post and core to
restore the crown in nearly normal position. It must be remembered, however, that the long axis of the
remaining root and the crown must not be too dissimilar or undesirable forces will take place on the
structure supporting the root. Thus crown restorations may be used, but they will not cure severe
malalignment.

● Enameloplasty: Can be used to a lesser degree to correct malaligned teeth. It is possible to recontour
buccal or lingual surfaces to eliminate interferences to path of placement of major connector. Also
reshaping the facial or lingual surfaces of tipped or malposed teeth to allow better placement of clasps or
lingual plating.
This approach to the correction of malaligned teeth should always be given first consideration when
mouth preparation is planned, but it should be recognized that the amount of correction that can be
achieved is limited.

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Provision of support for weakened teeth
In many partially edentulous mouths some or all the remaining teeth have lost varying amts of the
supporting periodontal ligament and alveolar bone. To use these teeth to help support and stabilize a
RPD, it will be necessary to provide additional support for these teeth by splinting the teeth together or by
using overdenture abutments.

● Removable splinting
The premise behind splinting teeth with removable restorations is that mobility will either decrease or
remain the same.

● Fixed splinting
In cases when an individual tooth or 2 adjoining teeth may have lost some periodontal support as a result
of local conditions, decision must be made whether to retain or extract the teeth and the inclusion of the
teeth in the RPD.
A tooth with 50% loss of bony support (crown/root ratio- less than 1:1) and is being considered as a
terminal abutment tooth for class I or II partial denture would be a poor candidate for splinting to adjacent
tooth.
To be considered a permanent form of treatment, fixed splinting must be accomplished with full or partial
coverage crowns soldered together or pin-ledge restorations that provide additional retention for the
splint. Teeth that require splinting usually exhibit mobility. This mobility, if not completely controlled
may over time cause a break in the cementing medium with ultimate adverse effects on the tooth and
surrounding tissues. To attempt to control mobility with inlay restorations is not adviced. If the teeth
cannot be held totally immobile, splinting should not be attempted.
Fixed splinting on each side of the arch provides anteroposterior stability, and the removable major
connector (retained with extracoronal attachments like clasps or with intracoronal attachments) provides
the cross arch stabilization that is needed to resist lateral forces.

● Overdenture abutments
Certain teeth that have lost atleast 50% of the supporting bone but are strategically positioned in the arch
should be retained to provide support for the removable prosthesis. The support provided will consist
principally of resisting tissueward forces. If such teeth of a posterior end of an edentulous space are
retained and used as vertical stop for the denture base, the prostheses will be converted from a class I or II
partial denture to a functioning class III prosthesis. This change improves the function of the denture and
the patient acceptance is consistently excellent.

Reestablishment of arch continuity

There are times when a tooth stands alone at the distal aspect of a kennedy class I or class II partially
edentulous arch. Clinical experience indicates that placing a direct retainer on such a tooth (often termed
pier abutment) may lead to rapid destruction of the supporting periodontium and loss of tooth. For this
reason long standing abutments may receive rests but generally not clasped.

Recontouring proximal surfaces of posterior teeth:

Proximal recontouring always precedes preparation of rests to prevent sharp marginal ridges.
Recontouring proximal surfaces of posterior teeth reduces proximal undercuts. Also reduces gingival
embrasure space and lessens the possibility of food entrapment between tooth and minor connector or
proximal plate. Recontouring is also used to create proximal guiding planes, which provide a more
definitive path of insertion and removal, thus making clasps more retentive.

Enameloplasty to Develop Guiding Planes: Guiding planes are surfaces on proximal or lingual surfaces
of teeth that are parallel to each other and to the selected path of insertion of the removable partial
denture.

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Guiding Planes on Abutment Teeth Adjacent to tooth supported segments
Guiding planes are particularly effective when the edentulous spaces are tooth bounded.
The diagnostic cast, mounted on the surveying table at the tilt at which the design of the RPD was drawn,
should be available at the mouth preparation appointment. It should be placed on the bracket table in front
of the patient, and the handpiece, with appropriate diamond instrument in place, positioned over the cast
so that the relationship of the handpiece and diamond stone to the tooth can be visualized. This same
relationship can be duplicated in the patients mouth. This procedure ensures that the guiding plane will be
parallel to the planned path of insertion.
A cylindrical diamond point is generally the instrument used to make the preparation. A gentle light
sweeping stroke from buccal line angle to lingual line angle should be used. The flat surface created
should ideally be 2-4 mm occlusogingival height (5-6 strokes). Reduction should follow the curvature of
the surface so that nearly uniform amount of enamel are removed throughout the buccolingual width of
the preparation.

Guiding Planes on Abutment Teeth Adjacent to Distal Extension Edentulous Spaces

The tooth preparation on the proximal surface of abutment teeth adjacent to distal extension edentulous
spaces is accomplished in the same manner with a cylindrical diamond stone held parallel to the path of
insertion.
The principal difference between this guiding plane and the planes on teeth bordering a tooth-supported
segment is that occlusoginigival height of the plane is reduced to 1.5 to 2 mm to permit the partial
denture to rotate slightly around the distal occlusal rest as downward force occurs on the artificial teeth.
This slight movement allows the release of the denture from the guiding plane, thereby avoiding the
creation of torquring or twisting forces on the abutment tooth.

Guiding planes on lingual surfaces of abutment teeth

The purpose of providing guiding planes on lingual surfaces of teeth is to provide maximum resistances
to lateral stresses. The more teeth involved in guiding plane preparation, the less will be the stress
transmitted to each individual tooth. The occluso-gingival height of the preparation is 2 to 4 mm. The
plane ideally should be located in the middle third of the clinical crown of the tooth. Special care must be
shown to avoid changing the contour of the gingival third of the tooth because damage to the marginal
gingival through the improper shunting of food may occur if the normal morphology of the gingival third
of the crown is lost.

Guiding planes on Anterior Abutment Teeth

Guiding planes on anterior teeth adjacent to edentulous spaces provide the parallelism needed to ensure
stabilization, minimize wedging action between the teeth, decrease undesirable space between the denture
and the abutment tooth, and increase retention through frictional resistance.
Another special purpose of such guiding planes is to increase or restore the normal width of the
edentulous space. As anterior teeth are lost and replacement teeth not provided immediately, teeth
adjacent to the space will drift and tip into the space. Both actions reduce the size of the space and make
the esthetic replacement of the missing teeth difficult. In addition, teeth that have tipped toward an
edentulous space will exhibit a large undercut area below the height of contour on the proximal surface. If
the height of contour is not reduced as the guiding planes are established, the undercut will appear as a
large, unsightly space between the tipped tooth and the removable partial denture. The space not only
detracts from the esthetic value of the denture, but also traps food.
A cylindrical diamond stone is used to reduce the proximal surfaces of the adjacent teeth. The reduction
of these proximal surfaces must be done with the path of insertion that has been planned. The reduction
must be parallel to this path of insertion because the reduced proximal surface will act as guiding plane. If
the required changes cannot be made without penetrating into the dentin, an appropriate restoration
should be planned.

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Enameloplasty to Change Height of Contour
The height of contour is changed most frequently to provide better positions for clasp arms or for lingual
plating. Ideally the retentive clasp arm should be located no higher on the crown of the abutment tooth
than the juncture of the gingival and middle thirds. This position not only enhances the esthetic quality of
the clasp, but also provides a definite mechanical advantage (places the clasp nearer the tooth’s center of
rotation). Maxillary molars and premolars, if unsupported in an arch that lacks continuity, tend to tip in a
buccal direction. This causes the height of contour to be near the occlusal surface on the facial side of the
abutment tooth. A clasp in this position on the maxillary molars or premolars is esthetically unacceptable.
The reverse condition exists in the mandibular arch. Premolar and molar teeth in this arch, if not
supported will tip lingually. This usually causes problems with positioning reciprocal clasps and lingual
plating and, if the tipping is severe, with the placement of the lingual bar major connector.
The amount of correction that can be accomplished by reencountering the enamel surface is limited by the
thickness of the enamel. The height of contour is best lowered by using tapered diamond stones. Minor
reshaping of buccal and lingual surfaces can greatly improve mechanical and esthetic properties.

Enameloplasty to Modify Retentive Undercuts (dimpling)

Occasionally abutment tooth has less than a sufficient retentive undercut. If the oral hygiene of the patient
is adequate and if the caries index is low, some of these teeth may be treated to increase the amount of
retentive undercut by contouring the enamel surface.
In order for the technique of contouring the enamel surface to produce a retentive undercut to be
successful, the buccal and lingual surfaces of the tooth must be nearly vertical. If either or both surfaces
have a pronounced slope, the procedure is contraindicated. If the surface to receive the undercut is sloped,
the indentation would have to be excessively deep to be effective. The retentive undercut must be created
in the form of a gentle depression, not a pit or hole. The process is termed as dimpling consists of
preparing a small indentation or dimple in the enamel of the tooth surface into which the retentive clasp
can be placed.
The depression or undercut is prepared by using a small, round-ended, tapered diamond stone. The end of
the stone is moved in an anteroposterior direction near the line angle of the tooth. The preparation is made
parallel to and as close as possible to the gingival margin without actually encroaching on the gingival
crevice. The purpose is to create a slight concavity approximately 0.010 inch deep measured from a
vertical line paralleling the path of insertion. The depression should be approximately 4mm in mesiodistal
length and 3mm in occlusogingival height. Care must be taken not to develop a ledge or shoulder in the
enamel. A favored site for this alteration is an interproximal area, where the enamel is thick and where the
retentive terminal of the clasp is customarily placed. The preparation must be highly polished with a
carborundum-impregnated rubber wheel and point.

Complete and partial- coverage restorations

Restorations may be required for teeth displaying caries lesions, deflective restorations, fracture, or
endodontic therapy. If the remaining teeth do not possess usable contours and the enamel surfaces cannot
be modified to produce these contours, complete- or partial-coverage restorations may be required. These
restorations must be carefully planned and constructed and must include the appropriate undercuts,
guiding planes, and rest seats.

Occlusal Rest
The components of a RPD that serve primarily to transfer forces occurring against the prosthesis down
the long axis of the abutment teeth are called rests and a rest seat is prepared surface of the tooth or fixed
restoration into which a rests fits.

Function of the occlusal Rest

1. Transmit stress along the long axis of the tooth.
2. Prevents gingival displacement of a RPD

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 3. Secure the clasp in its proper position on the tooth in order to maintain a desired tooth-clasp
and tooth-base relationship.
4. Prevent a spreading of the clasp arms, with subsequent displacement of the clasp and the
prosthesis.
5. Assist in distributing the occlusal load between two teeth or more so that each can bear a
proportionate share of the masticatory load in concert with the residual ridges.
6. Prevent extrusion of the abutment tooth.
7. Prevent the ingress of food between the abutment tooth and the clasp, by deflecting it away
from the immediate area.
8. Provide resistance to lateral displacement of the prosthesis.
9. Contribute indirect retention (in some cases).

Occlusal Rest Seat Preparation in Enamel: The outline form of an occlusal rest seat is basically
triangular, with the base of the triangle at the marginal ridge and the apex pointing toward the center of
the tooth. The apex of the triangular should be rounded, as should all external margins of the preparation.
The outline form of the occlusal rest essentially follows the shape of the mesial or distal fossa of the
surface of the tooth in which the rest is prepared.
The floor of the occlusal rest seat must be inclined toward the center of the tooth and must be spoon
shaped. The enclosed angle formed by the inclination of the floor of the rest and the vertical projection of
the proximal surface of the tooth must be less than 90 degrees.
An occlusal rest must be at least 1 mm thick at its thinnest point if chrome alloy is used for the
framework; 1.5mm if gold is to be used. The extension of the rest seat preparation should vary from one-
third to one-half the mesiodistal diameter of the tooth, seldom less than 3 mm. The buccolingual extent
should be half the distance between the buccal and lingual cusp tips.
Many practitioners use round diamond burs, while others prefer diamond burs with rounded ends and
tapering sides (are less likely to produce such undercuts and therefore provide distinct advantages.
An effective method for evaluating the anatomy and depth of preparation involves the use of red boxing
wax which is formed into a disc and pressed firmly against the occlusal surface of the prepared tooth.
Subsequently the patient is instructed to close firmly and to maintain closure for 5 sec. patient is directed
to open and wax is gently removed.
Finishing procedures are performed using a green stone in slow speed handpiece and polishing with
small, carborundum impregnated rubber point

Occlusal Rest Seat Preparations In New Gold Restorations (wax pattern): Occlusal rest seats in cast
gold restorations should always be placed in the wax pattern stage. The preparation for the rest seat must
be carved in the wax after the establishment of guiding planes if guiding planes have been planned for the
abutment tooth. It is essential that sufficient occlusal clearance be provided to permit proper dimensions
of the rest seat. To prepare the rest seat in the wax pattern, a no. 4 round steel bur can be used. The
sequence is the same as that used to prepare the rest seat in enamel. Slow engine speed and light pressure
must be used. The rest seat can also be carved with suitable wax instruments (small excavators or the
cleoid and discoid). If an unusual tilt, particularly a lateral tilt of the diagnostic was selected it is possible
to carve an undercut to the path of insertion.

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Occlusal Rest Seat Preparation In Existing Gold Restorations: There will be times when a removable
partial denture is indicated for a patient who has cast restorations on teeth that must serve as abutments
for the prosthesis. If the existing restorations display marginal integrity and occlusal harmony an attempt
should be made to contour them to satisfy the requirements of the proposed prosthesis. It is usually not
too difficult to prepare acceptable guiding planes in existing restorations. The greatest problem arises in
developing adequate rest seats. Patients must always be thoroughly warned of the possibility of needing
to replace existing restorations before mouth preparation. If an existing crown, onlay, or inlay is
penetrated during the rest seat preparation, the restoration must be replaced.

Occlusal Rest Seat Preparation In Amalgam Restorations: An occlusal rest preparation in a multi
surface amalgam restoration is less desirable than that in either sound enamel or a gold restoration.
Amalgam alloy tends to flow when placed under constant pressure. Care must be taken not to weaken the
proximal portion of the amalgam restoration at the isthmus during the preparation. This may result in
fracture during function. Rest seats are prepared in the amalgam restoration the same as in enamel that a
no.4 round bur is used instead of the diamond stone. The preparation is polished by reversing the
revolutions of the no.4 round bur. A final polish is obtained by polishing the amalgam as any other
amalgam restoration.

Rest Seat Preparation For Embrasure Clasp: This preparation extends over the occlusal embrasure of
two approximating posterior teeth, from the mesial fossa of one tooth to the distal fossa of the other tooth.
Insufficient tooth removal will generally lead to occlusal interferences between the metal of the clasp and
the opposing cusps. Relieving the metal to gain occlusal freedom ultimately leads to breakage of the clasp
during function. Repair of the embrasure clasp is usually difficult. A small round diamond stone is used to
establish the outline form for a normal occlusal rest in each of the approximating fossae. Each marginal
ridge should be reduced the same amount. The contact point between the teeth should not be broken
because a wedging action and food impaction between the teeth may take place if the contact is lost.
An alternate method for obtaining clearance is by the use of a cylindiric diamond stone held horizontally
from the buccal surfaces of the teeth pointing toward the lingual surface. The stone is held against the
distal incline of the buccal cusp of the tooth and the mesial incline of the buccal cusp of the other tooth.
The occlusal clearance may be checked by laying two-piece of 18-guage wire side by side by side-by-side
across the preparation may check the occlusal clearance. The patient should be able to close without
contacting the metal. A normal verification available is made by making an impression with red utility /
boxing wax and measuring the thickness of the wax with the Boley gauge. As the preparation passes over
the buccal and lingual embrasures, which should be approximately 3.0 to 3.5 mm wide and 1.5 to 2 mm
deep. The buccal inclines of the preparation must be rounded after the preparation is complete.

Rest Seat Preparation for Anterior Teeth

Lingual, or Cingulum, Rest on Canine and Incisor Teeth: An occlusal rest on a molar or a premolar is
preferred over a lingual or an incisal rest on anterior teeth to provide support for a partial denture. Forces
are better directed down the long axis of the abutment tooth by an occlusal rest than by a lingual or incisal
rest. A canine is preferred over an incisor for support of a denture. When a canine is not present; multiple
rests on incisor teeth are needed in place of a single rest on a single incisor tooth. A lingual rests is
preferred to an incisal rest. The lingual rest can be prepared nearer the rotational center of the tooth,
preventing the tipping action that an incisal rest may produce. Lingual rests are also more acceptable
esthetically and less subject to breakage and distortion.
The outline from the lingual rest seat is half moon shaped. It should form a smooth curve from one
marginal ridge to the other, crossing the center of the tooth incisally to the cingulum. The deepest point of
the rest seat will be over the cingulum.

To prepare the lingual rest in enamel: A No. 38 carbide bur (inverted cone with side- and end-cutting
surfaces) in a high speed handpiece is used. The bur is oriented at a slight angle to the lingual surface of

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the tooth. An improperly held disk or other diamond instrument can produce under cuts in the
preparation. The cut with the disk should start low on one marginal ridge, pass over the cingulum, and
then pass gingival to contact the opposite ridge. This will produce the desirable half moon or crescent
shape.

Incisal Rest Seat Preparation: The incisal rest seat is usually placed near one of the incisal angles of
canines. If the incisal rest is used in conjunction with a circumferential clasp, the rest should be placed at
the distal incisal angle. If the rest is used in conjunction with a vertical projection or bar clasp that uses a
distal buccal under cut for retention, the preparation should be made at the mesial incisal angle. In this
position the mesial incisal rest will reciprocate the action of the bar clasp more effectively than if it were
positioned at the distal incisal angle. On incisor teeth an incisal rest usually used as a last rest to stabilize
the removable prosthesis.
The incisal rest seat preparation is begin with a small safe side diamond disk or a knife-edge stoned held
parallel to the path of insertion. The first cut is made vertically 1.5 to 2 mm deep in the form of a slice or
notch and approximately 2 – 3 mm inside the proximal angle of the tooth. A small flame shape diamond
point is used to complete the preparation.
The notch created by the disk must be rounded. The base of the notch is also rounded with the tip of the
flame shaped diamond shape. The groove that results after the notch has been completely rounded must
be carried slightly over on to the labial surface. This projection on to the facial surface provides a locking
device to prevent the tooth from being tipped or moved facially. The groove should be continued part way
down the lingual surface as an indentation. This indentation will help accommodate the minor connector.

References
 Carr AB, Mc Givney GP, Brown DT, McCracken’s Removable partial prosthodontics, 11 th
Edition, India, Elsevier publication, 2006; Pp: 231-270.
 Stewart. KL, Rudd KD, Kuebker WA, Clinical Removable partial prosthodontics, 2 nd Edition,
India, All india Publishers and distributors, 2005; Pp: 277-316.
 Osborne J, Lammie G A, Partial dentures, 4th edition, Delhi, CBS publishers, 1985, Pp: 102-142
 Davenport et al, Tooth preparation, BDJ 2001;190(6):288-294

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